QuestionHi! I am a 30 yr old female and I am wondering if you could tell me whether I need to discuss my lab work further with my doctor. In 2007 my lab work showed a positive ANA Anti-nuclear titer (1:640)with centromere pattern. My recent bloodwork (Nov. 2009) showed the following abnormalities: MPV 7.3 (normal 7.5-11.5) and total cholesterol 231 (normal 125-200). My HDL cholesterol was in range though. My urinalysis showed up with a cloudy appearance and small (1+) leukocyte esterase. I know I need further testing regarding my ANA as I'm showing vague symptoms associated with CREST syndrome. Should I be concerned at all about any of my other bloodwork. Thank you!
Carol
AnswerCholesterol
Leukocyte esterase
To fully understand what the MPV means, it's necessary to understand he CBC testing procedure itself and what the CBC results mean. A CBC is a Complete Blood Count.
For a CBC, a sample of blood is drawn from the patient in a lavender top vacutainer tube containing EDTA, an anticoagulant to keep the blood from clotting so it can be tested. The blood is composed of red blood cells and different types of white blood cells which are all responsible for different functions within the body such as immunity to bacterial or viral or parasitic diseases, allergies, clotting. For example, neutrophils are elevated in bacterial infections lymphocytes are elevated in viral infections, monocytes help identify and rid the body free of specific foreign substances and organisms including bacteria, eosinophils are elevated in allergies and parasitic infections, basophils are elevated in allergies, and platelets are responsible for initiating the clotting process. These cells are all of different sizes and appearance under the microscope and are all present in different percentages in the peripheral bloodstream (blood vessels of the body).
In the hospital lab or doctor's clinical lab, the patient's blood sample is analyzed by a machine (electronic analyzer) called a Coulter. The Coulter machine counts each type of blood cell and based on its size, classifies it as a specific type of blood cell, for example a lymphocyte or a red blood cell. If the sizes of the cells are unexpected for the type of blood cell the machine has classified it as, it flags the CBC report for a manual differential so the medical technologist can further evaluate it by looking at a stained blood smear on a glass slide under a low and high powered microscope.
The difference in the size and percentages and averages of these blood cells in the patient's blood specimen is the principal on which the Coulter count, which generates the CBC report, is based. The Coulter counts the number of red blood cells (RBCs) and white blood cells (WBCs) in the patient's blood specimen and classifies them based on their size and shape and compares the sizes and percentages of each blood cell to the normal reference range of size and percentage that it expects them to be. The CBC report reports the size and percentage of each type of blood cell.
If the cell sizes and percentages fall within the normal reference range, then the CBC results are reported as normal.
Sometimes when the cell sizes and percentages fall outside of the normal sizes and percentages the Coulter expects them to be based on their size and resulting classification the Coulter flags the CBC result for a manual differential count.
For this test, the medical technologist prepares a blood smear on a glass slide using a special technique, stains it for better visualization of the cellular components, and examines it under both low and high power under a microscope.
The patient's CBC and manual differential lab results are then accessed by the doctor via a computerized results reporting system.
The following website shows a picture of a Coulter.
http://wpcontent.answers.com/wikipedia/commons/thumb/1/1d/CBC_report.JPG/200px-C...
The website below shows a picture of normal RBCs (red blood cells) on a blood smear prepared for a manual differential. The blood is stained using a special stain called Wrights stain which makes the one lympohocyte (a WBC which is responsible for fighting viral infections) in this picture look purple. The remaining cells in the picure are RBCs.
Then in a specific area of the slide where the cells are 1 cell layer thick, called the zone of morphology, the medical technologist examines the red and white blood cells on the blood smear on the glass microscope slide under both low power and high power microscope.
Platelets are the WBCs that are responsible for initiating the clotting process. The slide below shows a patient's blood smear with a normal MPV or mean platelet volume. The platelets are the smallest WBCs and look like blue dots on the photo micrograph.
http://mmserver.cjp.com/images/image/4303018.jpg
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MPV - Mean Platlet Volume
http://images.google.com/imgres?imgurl=http://aux.shenkar.ac.il/2000/group36/Pic...
Mean Platelet Volume - gives us an information about the size of the Platelet. The size of the Platelet will give us indication about the platlet age (the maximum is 8 days) and her function.
Platelets are the smallest cell-like structures in the blood and are important for blood clotting and plugging damaged blood vessels. When the blood vessels are harmed and the blood is coming out the platlets aggregate (joins) together to produce some kind of a temporary bridge - so the blood wont get out for more then few seconds. The amount is very important and a lower amount can tell us mainly two things - or that the production is not sufficient, or that somewhere in the body there is consumption (usage) of the platlets.
MPV: The normal adult human has between 7.4-10.4.
Platlet: The normal adult human has between 150,000 - 400,000 (per microliter).
http://aux.shenkar.ac.il/2000/group36/Picture/platelet.jpg
Here is a picture of small platelets. Because your platelet size does not vary significantly from normal reference range it may or may not be significant since reference ranges are based on patient populations and can vary slightly depending on the patient population from which the reference range was determined. Without knowing the other lab values such as the CBC results it's not possible to know what if any significance there is for this value. You may want to ask your physician. Were any of your other values out of range?
Regarding your leukocyte esterase, what were your other urinalysis values? Were your WBCs above reference range? Were any bacteria seen? Leukocyte esterase is produced by neutrophils, the WBCs that are increased in bacterial infections. Do you have symptoms of a UTI? Most UTIs are caused by E. coli, which is normal flora for the colon but not for the urinary tract.
Regarding your cholesterol, it should be below 200 total. The fact that your HDL is high is good and exercise increases HDL cholesterol.
Below is a website which explains what the reference ranges mean
http://www.americanheart.org/presenter.jhtml?identifier=183#total
